They walk extra mile to save lives

This is the last Indian village along the international border in Uttar Pradesh. The Nepal border is barely 500 metres away from perhaps its closest neighbourhood. 

Fakirpuri is 120 km from the state’s Baharaich district headquarters.  One has to drive through 53 km of dense forests and lush green fields from Mihinpurwa block to reach this small village dominated by the Tharu tribe with a population of about 1,440.  Tharu community is an ethnic group indigenous to the Terai region (Himalayan foothills) in India and Nepal.

Inaccessibility and proximity to the international border make this village difficult to reach. Mobile and internet connectivity is also poor. Other than the deployment of security forces, an anganwadi centre and a primary school there are no other traces to show the administration’s presence.

The healthcare system operates from a sub-centre, which is situated about 8 km away. The Aamba sub-centre is run by an auxiliary nurse midwife (ANM) Sumitra Devi and assisted by an accredited social health activist (ASHA) Prem Kumari, who is the first port of call in case any health-related issue arises. If Sumitra Devi has been instrumental in ensuring the safety of young mothers and children since 1989, Prem Kumari has been promoting ante-natal care, institutional deliveries, postpartum care, immunisation and even family planning. The closest tertiary care facility is the District Hospital at Baharaich. 

“It is very challenging but satisfying also,” says Sumitra with a smile. “The community also contributes its bit in running the show,” she adds.

Just a few months back during the monsoon season, the region had witnessed massive floods and the village had been totally cut-off from the mainland resulting in acute shortage of drinking water, vaccines and medicines at the sub-centre with the threat of water-borne diseases looming large.

The ANM started functioning from a nearby sub-centre where her mobile was partially functional. The sub-centre was not totally submerged.  One of the ASHAs coordinated with the community resource person – posted by the technical support unit which is helping the Uttar Pradesh government in implementing a comprehensive programme to improve the maternal and child healthcare. She coordinated with the ANM to alert the staff at the one of the larger facilities in the block regarding the urgent need for medicines, vaccines and clean water.

The staff from the Motipur Primary Health Centre brought supplies to the sub-centre where the ANM was stationed at that time. To transport the medicines and vaccines to the flooded area of the block, local villagers packed them in polythene bags which they tied to their bodies. The villagers used rubber tubes to swim across the flooded area, ferrying supplies to Aamba sub-centre and Fakirpuri village.

Even during normal times, Sumitra Devi has to fetch medicines and vaccines from Bicchiya railway station, approximately 15 km from  Fakirpuri, and the last rail head to the region, on her scooter. Alternately, when she goes for the weekly cluster meetings, she picks up the required stock.

Prem Kumari has been running the show efficiently. She has all details on her fingertips and narrates without hesitation that there should to be 39 pregnant women registered with her as per the population norms. Her village and health index register (VHIR) was updated and she was proficient in discussing the five key indicators of mother and child care-- registration, ANC, Institutional Delivery, PNC and use of contraceptives.

Despite all these initiatives, some deliveries still take place at home. This was primarily because of lack of mobile connectivity. “The BSNL connectivity here is not very good and sometimes it is not possible to call an ambulance. Therefore, we have to plan the birth well in advance. I tell families that they should make alternative arrangements for deliveries just in case the ambulance could not arrive,’’ she says. But, there are times when deliveries are done at home due to logistical problems, she explains. She was trained in home-based neonatal care as well.

“ASHA batayin raha kewal apna doodh pilana pani bhi nahi dena,’’ (ASHA had asked me to feed the child only breast milk), said a lactating mother, when asked what she learnt from ASHA. She is a highly respected individual in the village with people taking her seriously. The umbilical cord of Sumitra’s new born child was dry and nothing was applied, which normally is the practice in the communities. Her husband said he would have the second child only after a gap of at least four years, and her wife would opt for intra uterine contraceptive device. A large number of eligible couples have opted for modern methods of contraception.

But this change did not come overnight. According to Prem Kumari, whenever she used to ask women to adopt family planning methods, some would tell her that she also had two children, so why had she not opted for sterilisation. “Then I decided to set an example and opted for sterilisation,” she said. Interestingly, the community does not hanker after male child and there is no discrimination between girls and boys. Girls are, in fact, called “babu”, something often used for boys. The use of “babu” explains the status of girls.

“The induction of community resources persons has brought about a massive change in the healthcare systems in far-off areas. She coordinated well with the frontline workers and services are being delivered, and little wonder then that healthcare indicators are improving at all levels,’’ Jairam Pathak, Zonal Community Specialist, said.